The prognostic and discriminatory utility of the Clinical Frailty Scale and modified frailty Index compared to age

TY - JOUR

T1 - The prognostic and discriminatory utility of the Clinical Frailty Scale and modified frailty Index compared to age

AU - Carter, Ben

AU - Keevil, Victoria

AU - Anand, Atul

AU - Osuafor, Christopher

AU - Goudie, Robert

AU - Lowry, Matthew

AU - Clunie, Sarah

AU - Shenkin, Susan

AU - McCarthy, Kathryn

AU - Hewitt, Jonathan

AU - Quinn, Terry J.

PY - 2022/8/21

Y1 - 2022/8/21

N2 - There is no consensus on optimal methods for frailty assessment. We compared prognostic utility of two approaches (modified Frailty Index [mFI], Clinical Frailty Scale [CFS]) in older adults (≥65 years) hospitalised with COVID-19 versus age. Methods: We used a test and validation cohort that enrolled participants hospitalised with COVID-19 between 27th February to 30th June 2020. Multivariable mixed-effects logistic modelling were undertaken, with 28-day mortality as primary outcome. Nested-models were compared between a base model, and age and frailty assessments using likelihood ratio testing (LRT) and an area under the receiver operating curves (AUROC). Results: The primary cohort enrolled 998 participants from 13 centres, the median age was 80 (range:65-101), 453 (45%) were female and 377 (37.8%) died within 28 days. The sample was rep-licated in a validation cohort of two additional centres (n=672) with similar characteristics. In the primary cohort both mFI and CFS were associated with mortality in base models. There was improved precision when fitting CFS to the base model +mFI (LRT=25.87,p<0.001), however no improvement fitting mFI to the base model +CFS (LRT=1.99,p=0.16). AUROC suggested increased discrimination fitting CFS compared to age (p=0.02) and age +mFI (p=0.03). In contrast, the mFI offered no improved discrimination in any comparison (p>0.05). Similar findings were seen in the validation cohort. Conclusions: These observations suggest the CFS has superior prognostic value to mFI in predicting mortality following COVID-19. Our data do not support the use of the mFI as a tool to aid clinical decision making and prognosis.

AB - There is no consensus on optimal methods for frailty assessment. We compared prognostic utility of two approaches (modified Frailty Index [mFI], Clinical Frailty Scale [CFS]) in older adults (≥65 years) hospitalised with COVID-19 versus age. Methods: We used a test and validation cohort that enrolled participants hospitalised with COVID-19 between 27th February to 30th June 2020. Multivariable mixed-effects logistic modelling were undertaken, with 28-day mortality as primary outcome. Nested-models were compared between a base model, and age and frailty assessments using likelihood ratio testing (LRT) and an area under the receiver operating curves (AUROC). Results: The primary cohort enrolled 998 participants from 13 centres, the median age was 80 (range:65-101), 453 (45%) were female and 377 (37.8%) died within 28 days. The sample was rep-licated in a validation cohort of two additional centres (n=672) with similar characteristics. In the primary cohort both mFI and CFS were associated with mortality in base models. There was improved precision when fitting CFS to the base model +mFI (LRT=25.87,p<0.001), however no improvement fitting mFI to the base model +CFS (LRT=1.99,p=0.16). AUROC suggested increased discrimination fitting CFS compared to age (p=0.02) and age +mFI (p=0.03). In contrast, the mFI offered no improved discrimination in any comparison (p>0.05). Similar findings were seen in the validation cohort. Conclusions: These observations suggest the CFS has superior prognostic value to mFI in predicting mortality following COVID-19. Our data do not support the use of the mFI as a tool to aid clinical decision making and prognosis.

M3 - Article

SN - 0016-867X

JO - Geriatrics

JF - Geriatrics

ER -